The primary objective of this U10 Grant application, on behalf of the Surgery Modality Committee of the CALGB, is to facilitate the full integration of surgeons into the scientific agenda of the Group. Among the major functions of the Surgery Modality Committee will be to implement a comprehensive quality control and quality assurance program, which will be applied to all protocols which employ surgery. Adequate on-site surgical data management will be established within each CALGB institution to provide practical support for the expanding surgical activity within the Group. Furthermore, an institutional Surgical Coordinator has been named at each CALGB institution to review and monitor each institution's surgical activities, and to encourage broader participation in order to increase accrual to CALGB protocols. In order to serve as a platform for intellectual activity, three surgery cadres, the Thoracic Surgery Cadre the Gastrointestinal Surgery Cadre, and the Breast Surgery Cadre, have been established to work in concert and close collaboration with the respective Disease Core Committees within the CALGB. This grant application is not a competing intellectual thrust being developed outside the Disease Committee structure, and protocols developed with surgical leadership will remain under the aegis of the Disease Committee agenda. However, with the appropriate framework established, CALGB surgeons will contribute scientifically and intellectually to the development of protocols that test new surgical strategies. Surgical themes to be pursued include testing minimally invasive surgical techniques, testing new surgical techniques and technology, and testing multimodality treatment approaches. The establishment of tissue procurement facilities for the collection of tumors within the CALGB will provide a tremendous resource for correlative science projects to support translational research on human tissues. Tissue banks have already been established on a pilot basis at four CALGB institutions, and while specimens are banked and stored separately at each institution, they will be made collectively available to Group science. The Thoracic Surgery Cadre has contributed significantly to protocol development within the CALGB. Two prospective randomized phase III investigations are about to commence in Stage IIIA and in Stage II non- small cell carcinoma of the lung (NSCLC). In addition, projects are under development in Stage I NSCLC, as well as to study video assisted thoracoscopic surgery, and pulmonary exercise testing as a tool for operative selection in patients with lung cancer. The Gastrointestinal Surgery Cadre has taken a leadership role in an ongoing protocol for conservative treatment of rectal carcinoma. Initiatives are also either ongoing or under development for adjuvant chemoradiation for gastric carcinoma, combined chemotherapy/radiation for treatment of poor prognosis anal carcinoma, adjuvant treatment of rectal carcinoma, gamma detecting probe directed surgery, esophageal cancer, laparoscopic colectomy for colorectal cancer, and perioperative chemotherapy for colorectal cancer. Finally, the Breast Surgery Cadre has taken a leadership role in developing a protocol for breast cancer treatment in the geriatric population.